Provider Demographics
NPI:1033144654
Name:SMITH, ASHLEY ELIZABETH (SLP)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:CAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:10405 E NORTHWEST HWY STE 302
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4601
Mailing Address - Country:US
Mailing Address - Phone:972-755-9157
Mailing Address - Fax:
Practice Address - Street 1:10405 E NORTHWEST HWY STE 302
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4601
Practice Address - Country:US
Practice Address - Phone:972-755-9157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114244235Z00000X
IL146010534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114244OtherSLP LICENSE
TX1761710-01Medicaid